Congenital rubella syndrome in Iran.

Jila Sadighi,Kazem Mohammad,Hasan Eftekhar

doi:10.1186/1471-2334-5-44

Abstract

BackgroundCongenital rubella syndrome (CRS) can be prevented with appropriate vaccination programs. The prevalence rates of rubella and CRS in Iran are unknown; therefore, the risk of exposure in pregnant women is not clear. The prevalence of CRS in the pre-vaccine period can be estimated by evaluating the proportion of children in the population with sensorineural hearing loss attributable to rubella.MethodsThis was a case-control study to estimate prevalence of CRS in Tehran (Iran) by evaluating the proportion of children with sensorineural hearing loss attributable to rubella. The study used rubella antibody titer as an indicator, and compared the prevalence of rubella antibody between children with and without sensorineural hearing loss. Using these findings, the proportion of cases of sensorineural hearing loss attributable to rubella was estimated.ResultsA total of 225 children aged 1 to 4 years were entered into the study (113 cases and 112 controls). There was a significant difference between cases and controls with regard to rubella antibody seropositivity (19.5% vs. 8.9%, respectively, odds ratio = 2.47, 95% CI = 1.04–5.97). The proportion of sensorineural hearing loss cases attributable to rubella was found to be 12%, corresponding to a CRS prevalence of 0.2/1000.ConclusionThe prevalence of CRS was approximately 0.2/1000 before rubella vaccination in Iran, Moreover; the results suggest that implementation of appropriate rubella vaccination programs could potentially prevent about 12% of cases of sensorineural hearing loss in Iranian children. This data could potentially be used as baseline data, which in conjunction with an appropriate method, to establish a surveillance system for rubella vaccination in Iran. An appropriate surveillance system is needed, because the introduction of a rubella vaccine without epidemiological data and an adequate monitoring program could result in the shifting of rubella cases to higher ages, and increasing the incidence of CRS.

Highlights

Congenital rubella syndrome (CRS) can be prevented with appropriate vaccination programs
The present findings indicate that the prevalence of congenital rubella syndrome (CRS) in in Tehran (Iran) is approximately 0.2/1000 (Before rubella vaccination in Iran)
Sensorineural hearing loss is the most common abnormality associated with CRS, and it is the most common complication with late onset

Summary

Introduction

Congenital rubella syndrome (CRS) can be prevented with appropriate vaccination programs. The prevalence rates of rubella and CRS in Iran are unknown; the risk of exposure in pregnant women is not clear. The prevalence of CRS in the pre-vaccine period can be estimated by evaluating the proportion of children in the population with sensorineural hearing loss attributable to rubella. Rubella in pregnancy may cause abortion, stillbirth and congenital anomalies, or congenital rubella syndrome (CRS). In spite of the fact that 80% of pregnant women were immune to rubella in the United States, it is estimated that more than 12,500,000 cases of rubella occurred. Congenital rubella occurred in an estimated 30,000 pregnancies, with 10,000 resulting in fetal death or therapeutic abortion, and 20,000 resulting in infants born with CRS [3]. The estimated cost to the US economy was approximately $2 billion [4]

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